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Kaiser Permanente Senior Advantage Choice North (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Senior Advantage Choice North (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Senior Advantage Choice North (PPO) in 2025, please refer to our full plan details page.
Kaiser Permanente Senior Advantage Choice North (PPO) is a PPO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in Northern Colorado. The overall rating for this plan is not yet available for 2025.
It's important to know that Kaiser Permanente Senior Advantage Choice North (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Kaiser Permanente Senior Advantage Choice North (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Kaiser Permanente Senior Advantage Choice North (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $8950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Kaiser Permanente Senior Advantage Choice North (PPO) plan has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $5 copay at a preferred pharmacy for preferred generic drugs, and a $100 copay for preferred brand drugs. Once your total drug costs reach $2,000, you will enter the next coverage phase. In the catastrophic coverage phase, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Kaiser Permanente Senior Advantage Choice North (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay of $295 for days 1-5, with no copay for days 6-90, while outpatient services and emergency services have copays that vary depending on the service. The plan also includes benefits such as vision, hearing, and dental services with copays, as well as coverage for home health, and skilled nursing facilities. This plan provides coverage for primary care with no copay, as well as preventive services. The plan also covers ambulance and transportation services with copays, and offers additional benefits like over-the-counter items. However, it's important to note that certain services such as routine chiropractic care, podiatry, and orthodontics are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization and a doctor referral. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-5, and no copay for days 6-90; additional days for Inpatient Hospital-Acute have no copay.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a $250 copay, ASC services have a $185 copay, individual outpatient substance abuse sessions have a copay between $25-$25, group outpatient substance abuse sessions have a copay between $15-$15, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization and a doctor's referral. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $340 copay for both ground and air ambulance services, and no coinsurance. Transportation services to a plan-approved health-related location are covered for up to 18 one-way trips per year with no copay and no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Kaiser Permanente Senior Advantage Choice North (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services and Worldwide Urgent Coverage have a $35 copay, and Worldwide Emergency Transportation has a $340 copay; all have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, while Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $30 copay, and Mental Health and Psychiatric Services have a copay between $15 and $25 depending on the service. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Additional Telehealth Benefits have no copay. Opioid Treatment Program Services have a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam with no copay. Additional preventive services, kidney disease education, and other preventive services are also covered, with the copay varying depending on the specific service. Some services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $10 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) are covered up to $400 every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a copay of $0-$30, while eyewear has a combined maximum plan benefit of $500 every year.
Dental Services See details
Kaiser Permanente Senior Advantage Choice North (PPO) covers Medicare Dental Services with a $30 copay, oral exams and dental x-rays with no copay, and other diagnostic dental services, prophylaxis (cleaning), and fluoride treatment with no copay. Restorative Services have a 30% coinsurance, endodontics and periodontics have a 50% coinsurance, and implant services have a 50% coinsurance. Orthodontics is not covered, and other dental services may be optional.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Senior Advantage Choice North (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs also have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, and a doctor referral is required. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts and Prosthetic Devices have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, are covered. Diagnostic Procedures/Tests have no copay, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $145, Therapeutic Radiological Services have a copay of at most $30, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by Kaiser Permanente Senior Advantage Choice North (PPO) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. A doctor referral is required, and there is a copay for covered services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Kaiser Permanente Senior Advantage Choice North (PPO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20 and days 47-100, and a $203 copay for days 21-46. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services with the Kaiser Permanente Senior Advantage Choice North (PPO) plan covers over-the-counter (OTC) items with a maximum plan benefit coverage amount of $90.00 every three months, and other services with coinsurance between 0% and 20%, but acupuncture, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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